Pharmacepidemiology in the elderly: medications pneumonia risk and confounding

老年人药物流行病学：药物肺炎风险和混杂因素

• 批准号: 7907677
• 负责人: SASCHA DUBLIN
• 金额: $ 16.64万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-15 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7907677
• 关键词: Accounting; Acids; Address; Adult; Affect; Age; Aging; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Anti-inflammatory; Aspirate substance; Award; Benefits and Risks; Benzodiazepines; Clinical; Clinical Trials; Cognitive; Cohort Studies; Communities; Comorbidity; Coughing; Data; Dementia; Disease Outcome; Elderly; Epidemiologic Studies; Event; Future; Geriatrics; Goals; Health; Impaired cognition; Instruction; Integrated Delivery of Health Care; Internal Medicine; Laboratories; Lead; Life; Link; Lower respiratory tract structure; Measures; Medical Records; Mentors; Methods; Morbidity - disease rate; Nested Case-Control Study; Observational Study; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Pneumonia; Population; Predisposition; Proton Pump Inhibitors; Provider; Reflex action; Research; Research Methodology; Research Personnel; Residual state; Resources; Risk; Risk Factors; Safety; Source; Stable Populations; Stomach; System; Testing; Training; Universities; Washington; Work; age related; career; computerized; follow-up; functional disability; functional status; human HRH2 protein; improved; mortality; pathogen; population based; programs; respiratory

DESCRIPTION (provided by applicant): Dr. Sascha Dublin is a Senior Fellow in General Internal Medicine at the University of Washington. She seeks to develop a career studying medication risks and benefits in the elderly. The elderly are often excluded from clinical trials, and thus observational studies-which may have important biases- are often the only source for information about medication effects in this population. Dr. Dublin will address a key methodologic problem in this field: bias due to confounding by cognitive and functional status. Through this award, she proposes to 1) gain additional background in aging research through didactic instruction; 2) pursue advanced training in relevant aspects of clinical geriatrics; and 3) conduct mentored research guided by her sponsors Drs. Eric Larson and Noel Weiss, distinguished researchers in the field of aging. RESEARCH: The goal of Dr. Dublin's research is two-fold. First, she will investigate associations between use of specific medications-acid-suppressing medications, benzodiazepines, angiotensin-converting enzyme inhibitors (ACEIs), and statins-and risk of pneumonia, a common and serious illness. Second, she will use this research to examine the impact of functional and cognitive status as confounders in studies of medication effects in the elderly. The results of some prior studies suggest that acid-suppressing medications and benzodiazepines are associated with increased pneumonia risk, while ACEIs and statins are associated with decreased risk. However, residual bias related to cognitive and functional impairment could explain all of these associations. She will carry out 3 linked projects within the Adult Changes in Thought cohort study, which includes more than 3300 elderly persons with 22,000 person-years of follow-up. Project 1 examines use of these 4 medication classes in relation to cognitive and functional impairment, and Project 2 evaluates cognitive and functional impairment as risk factors for pneumonia. Finally, Project 3 examines pneumonia risk in relation to use of these 4 medication classes, with adjustment for confounders including cognitive and functional status and comorbid illness. SIGNIFICANCE: This work will provide pilot data for future proposals and establish a direction for Dr. Dublin's future research career. It also will provide information on potentially reversible causes of pneumonia, a common and often devastating illness, and contribute to improved methods in studies of medication effects in the elderly.

描述（由申请人提供）： Sascha都柏林博士是华盛顿大学普通内科的高级研究员。她寻求发展一个研究老年人用药风险和益处的职业。老年人通常被排除在临床试验之外，因此观察性研究（可能存在重要偏差）通常是有关该人群药物效果的唯一信息来源。都柏林博士将解决这一领域的一个关键方法学问题：由于认知和功能状态的混淆而导致的偏倚。通过这个奖项，她建议1）通过教学指导获得额外的背景在老龄化研究; 2）追求在临床老年医学的相关方面的高级培训;和3）进行指导研究由她的赞助商博士埃里克·拉森和诺埃尔韦斯，在老龄化领域的杰出研究人员的指导。研究：都柏林博士的研究目标是双重的。首先，她将调查使用特定药物（抑酸药物、苯二氮卓类药物、血管紧张素转换酶抑制剂（ACEI）和他汀类药物）与肺炎（一种常见且严重的疾病）风险之间的关系。其次，她将利用这项研究来检查功能和认知状态的影响，作为老年人药物作用研究的混杂因素。一些先前的研究结果表明，抑酸药物和苯二氮卓类药物与肺炎风险增加相关，而ACEI和他汀类药物与风险降低相关。然而，与认知和功能障碍相关的剩余偏倚可以解释所有这些关联。她将在成人思想变化队列研究中开展3个相关项目，其中包括3300多名老年人，随访22，000人年。项目1检查了这4类药物的使用与认知和功能障碍的关系，项目2评估了认知和功能障碍作为肺炎的风险因素。最后，项目3检查了与使用这4类药物相关的肺炎风险，并对混杂因素进行了调整，包括认知和功能状态以及共病。意义：这项工作将为未来的提案提供试点数据，并为都柏林博士未来的研究生涯确定方向。它还将提供有关肺炎（一种常见且往往具有破坏性的疾病）的潜在可逆原因的信息，并有助于改进老年人药物作用研究的方法。